[心脏瓣膜手术围手术期卒中：发病机制、临床表现、诊断、预防、治疗]
[Perioperative stroke in heart valve surgery: pathogenesis, clinical findings, diagnosis, prevention, treatment].
作者信息
Tsygan N V, Andreev R V, Peleshok A S, Kolomentsev S V, Yakovleva V A, Ryabtsev A V, Gumennaya M A, Litvinenko I V
机构信息
Kirov Military Medical Academy, St. Petersburg, Russia; Konstantinov Petersburg Nuclear Physics Institute, Gatchina, Russia.
Kirov Military Medical Academy, St. Petersburg, Russia.
出版信息
Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(4):52-60. doi: 10.17116/jnevro20181184152-60.
AIM
To study risk factors, characteristics of clinical symptoms and diagnosis, and possibilities of prevention of perioperative stroke and other clinical types of cerebral dysfunction in main types of heart valve surgery.
MATERIAL AND METHODS
The study included 83 patients, aged 63 (54; 70) years, undergoing heart valve surgery with cardiopulmonary bypass.
RESULTS
Postoperative cerebral dysfunction was diagnosed in 37.3% of cases, including perioperative stroke in 3.6% of cases. In cases of aortic stenosis, the frequency of perioperative stroke was 9.5%. The cardioembolic subtype of perioperative ischemic stroke in cardiac valve surgery was most likely. The risk factors of the symptomatic delirium of the early postoperative period are: age over 75 years, preoperative frontal dysfunction, duration of artificial respiratory care more than 20 hours after the surgery.
CONCLUSION
The results suggest the efficacy of preventive use of cytoflavin for reducing the frequency and severity of perioperative stroke and symptomatic delirium of the early postoperative period in heart valve surgery with cardiopulmonary bypass.
目的
研究心脏瓣膜手术主要类型中围手术期卒中及其他临床类型脑功能障碍的危险因素、临床症状特征与诊断方法以及预防可能性。
材料与方法
该研究纳入了83例年龄为63（54；70）岁、接受体外循环心脏瓣膜手术的患者。
结果
37.3%的病例被诊断为术后脑功能障碍，其中3.6%的病例为围手术期卒中。在主动脉瓣狭窄病例中，围手术期卒中的发生率为9.5%。心脏瓣膜手术中围手术期缺血性卒中的心源性栓塞亚型最为常见。术后早期症状性谵妄的危险因素包括：年龄超过75岁、术前额叶功能障碍、术后人工呼吸护理时间超过20小时。
结论
结果表明，在接受体外循环心脏瓣膜手术时预防性使用细胞色素C可有效降低围手术期卒中和术后早期症状性谵妄的发生率及严重程度。
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